From the Guidelines
Cefepime can be used to treat Pseudomonas aeruginosa urinary tract infections (UTIs) as a fourth-generation cephalosporin with broad-spectrum activity, including against Pseudomonas species, although the most recent guidelines do not specifically mention cefepime for this indication. The European Association of Urology guidelines on urological infections, as summarized in the 2024 guidelines 1, recommend using an intravenous third-generation cephalosporin as empirical treatment for complicated UTI with systemic symptoms, but do not explicitly mention cefepime. However, considering cefepime's pharmacological properties and its classification as a fourth-generation cephalosporin, it is reasonable to infer its potential effectiveness against Pseudomonas UTIs, given its broad-spectrum activity. Key points to consider when using cefepime for Pseudomonas UTIs include:
- Dosage: Typically 1-2 grams administered intravenously every 12 hours for 7-14 days, depending on infection severity.
- Renal function: Dosage adjustment is necessary for patients with renal impairment.
- Resistance patterns: Local antibiotic resistance patterns should be considered, and susceptibility testing is recommended before initiating therapy.
- Alternatives: Fluoroquinolones, piperacillin-tazobactam, or carbapenems may be used if resistance to cefepime is suspected or confirmed, as per the guidelines for managing complicated UTIs 1.
From the Research
Cefepime Use for Pseudomonas UTI
- Cefepime is a broad-spectrum cephalosporin with potent in vitro activity against Pseudomonas aeruginosa 2.
- The use of cefepime for treating Pseudomonas aeruginosa infections, including urinary tract infections (UTIs), depends on various factors such as the minimum inhibitory concentration (MIC) of the isolate and the patient's renal function 3, 2.
- Studies have shown that cefepime can be effective against Pseudomonas aeruginosa infections, but the dosage and treatment duration may need to be adjusted based on the patient's condition and the susceptibility of the isolate 3, 4.
Pharmacodynamic Considerations
- Cefepime exhibits time-dependent bactericidal activity, and its effectiveness is maximized when the free drug concentration remains above the MIC of the infecting organism for 60-70% of the dosing interval 2.
- A study found that microbiological failure was associated with an fT > MIC of ≤60% 3.
- The use of cefepime for Pseudomonas UTI may be considered as an alternative to carbapenems, especially in cases where the isolate is susceptible to cefepime and the patient has normal renal function 5.
Clinical Outcomes and Treatment
- A retrospective study found that cefepime was effective in treating Pseudomonas aeruginosa infections in patients undergoing renal replacement therapy, with a 30-day survival rate of 72.7% and a clinical cure rate of 58.3% 4.
- Another study found that the 2020 EUCAST update led to an increase in carbapenem prescriptions and a decrease in anti-Pseudomonas cephalosporin prescriptions for UTIs and asymptomatic bacteriurias due to Pseudomonas aeruginosa 6.
- The choice of treatment for Pseudomonas UTI should be based on the susceptibility of the isolate, the patient's condition, and the potential risks and benefits of different antibiotic regimens 5, 6.